Respiratory failure remains the common most case of death in the first month of life in the United States. Extracorporeal membrane oxygenation (ECMO) has been used successfully to support neonates in this high risk category since 1975. More widespread application of this therapy has been limited by the size and complexity of these systems, and difficulties in transporting these patients. Development of a portable "briefcase" ECMO system with simplified operational and control features will greatly expand the availability and options for use of this form of therapy.